OVERVIEW Children are an important vector for the spread of influenza in households and communities. Healthy school-aged children have a high attack rate during annual influenza epidemics, and illness in this age group is associated with high rates of school absenteeism. Immunizing school-age children against influenza has been shown to result in significant reductions in influenza burden in other population groups as a result of decreased exposure to and transmission of influenza viruses. Therefore, focusing efforts for influenza vaccination on healthy children is an effective and practical strategy for reducing the burden of disease in the community. Currently, most influenza vaccination occurs in clinics, but little is known about the potential capacity of these clinical settings to meet any increase in demand. Schools offer an opportunity to deliver influenza vaccines to school-age children. However, schools have limited resources for health-related activities. Programs are needed which provide school-based influenza vaccinations to students in order to maximize immunization coverage. In the current proposal, a study team with extensive research experience in immunization delivery will investigate the feasibility, acceptability, and cost of implementing an influenza vaccination program at 20 schools in Denver and will develop a process for billing third party payers for the services rendered. This project will capitalize on relationships being developed for a pilot project in late 2008 that will provide Tdap to eligible adolescents in eight middle schools in the Denver Public Schools (DPS) district. Using the processes developed for implementing this pilot project, we will develop the necessary strategies to implement and then evaluate a school-based influenza vaccination program in partnership with Denver Community Health Services that will vaccinate children and bill third party payers. The program will plan to provide influenza vaccinations to eligible students at 20 elementary schools in DPS and bill the appropriate insurer for the services provided.